Few or Several Teeth (partially edentulous)
This section is aimed at those patients who are missing a few or several teeth. The technical term for this is ‘partially edentulous’. If you have lost a few teeth, either as a result of an accident or an injury then you are basically looking at a crown and bridge implant system.
If, however, you are missing quite a few teeth then you could be looking at extensive dental work. This type of treatment will involve implants but will also include bone/sinus grafts and quite possibly some major reconstructive work.
Are you missing just a few teeth?
If so then there are several different ways of performing this treatment although they all involve attaching crowns or a bridge onto an implant. These can be cemented or screwed onto the implants.
Crowns and bridges are constructed from a variety of materials such as ceramic, porcelain or a combination of metal and porcelain.
The traditional crown and bridge system was a short term answer to the problem of missing teeth but required the dentist to file down a couple of healthy teeth to act as ‘posts’ to support the bridge.
Another issue is that of bone loss. The traditional crown and bridge system does not prevent bone loss. Bone loss tends to happen when a tooth or teeth are lost and are not replaced. The jawbone becomes thinner and less dense and results in a sunken cheeked appearance.
The only way to prevent this is to combine the crown and bridge system with dental implants. The implants stimulate the bone cells within the jaw and stop any bone loss.
This procedure can be performed as part or all of the following:
- Implant crown and bridge
- Major maxillary reconstruction
- Major reconstruction
- Replacement of a failed blade implant
- Total dental care
Implant crown and bridge
This procedure involves several stages which start with the initial diagnosis, x-ray and wax impression of the patient’s jaw. Once this has been completed then the next stage is that of the insertion of the implant itself.
Once sufficient time has elapsed for osseointegration then the final stage is that of the restorations. The patient will have had temporary restorations during this time, but once the implants have completely fused then they are ready for the final restorations.
A bridge is required to span the gap left by the missing teeth along with laboratory constructed crowns.
Are you missing several teeth?
If you have lost several or nearly all of your teeth, or have a problem with your jaw joint, then you may require extensive reconstruction work. This can involve a bone graft, sinus lift, several implants and heavy restoration work.
Major Maxillary Reconstruction
This is an extensive procedure, designed to treat problems with teeth in the upper jaw or maxilla. If you have missing maxillary teeth, for whatever the reason then this procedure is an option.
This procedure is carried out on those patients who have been diagnosed with a tumour or have a maxilla related injury such temporomandibular disorder.
The procedure involves implants, a cast and restorations.
The same rules apply as above. The patient can be looking at the insertion of several implants, bone augmentation (possible) and/or sinus lift, and temporary restorations before the placement of the final restorations.
It can involve either the upper or lower jaw, or both.
So, what does it involve?
It involves bone grafting and/or sinus lifting, dental implants and plenty of restorative work in general. If you require this type of procedure then please be aware that it can be both expensive and time consuming. In some cases it can take up to two years to complete!
It also requires a high degree of skill and expertise on the part of the dentist.
A major reconstruction can take many different forms. It can involve a bone graft, a sinus lift or a condylar replacement.
A condlyar replacement is a procedure in which the dentist will insert a synthetic alternative to the mandibular condyle.
The latter is a procedure in which the dentist inserts stabilisation plates into the lower jaw. These plates are made of titanium and are designed to help the action of the mandibular condyles. A mandibular condyle is the technical name for the joint in the lower jaw which controls the opening and closing movement.
Think of it as a type of ‘hinge’ which will allow a smooth opening and closing action. These can be damaged as a result of an accident or injury and will require a replacement.
This is a complex procedure which requires a dentist with a great deal of experience and competence.
Replacement of Failing Blade Implant
A blade implant or plate form implant is a type of endosteal implant (implanted into the bone) which is less commonly used than the root form implant. It consists of a flat piece of metal (blade) with two prongs on one side of this metal. It is inserted into the jaw in such a way to support a bridge or crowns.
These along with other types of implants enjoy a high degree of success, usually around the 95% mark. But, failure can happen in a tiny minority of cases. This is usually due to a failure to fuse or ‘osseointegrate’ with the bone, inflammation (peri-implantitis) or fracture. Sometimes, implants can move around or shift out of position.
Whatever the reason an implant which is said to have ‘failed’, needs to be removed and replaced with a new one.
In this scenario, the failing blade implant will be removed and replaced by root form implants as part of a two stage process. The first stage will involve the removal of the defective implant and the second stage will be the placement of the new teeth or restorations.
Total Dental Care
This is the ‘full works’ in regard to dental treatment. It involves implants, crown and bridge restorations and porcelain veneers (also known as laminates).
This comprehensive treatment will involve a sinus lift plus a cast for the crown and bridge restorations. The veneers (laminates) are wafer thin shells, comprised of porcelain or ceramic, which are fitted over the front of the teeth in order to improve their appearance.
If your teeth are stained or damaged then consider this as an option.
Bilateral Sinus Lift
A bilateral sinus lift is surgery undertaken to build up the bone of the upper jaw. If the upper jawbone is too thin then implants cannot be inserted because there is not enough bone to hold them in place. A further complication is the fact that above this upper jaw is an air space or sinus which is unable to hold any type of implant.
The answer is to increase the width and depth of the upper jaw so that it will hold an implant firmly in place.
There are several types of sinus lift procedures and one of these is the bilateral lift. Bilateral in this case means two surgical procedures: the first is the actual sinus lift and the second is the insertion of dental implants.
Once the implants are in place and have fused then new teeth or restorations can be fitted.
Complete Fixed Reconstruction
This is carried out in order to replace badly worn teeth. It can involve the creation of a removable partial denture –for both the upper and lower jaw.
This denture is made from a cast which is made from an impression of the patient’s mouth. False teeth (restorations) are then fixed to this denture and this acts in much the same way as natural teeth.
However, a full reconstruction can involve work undertaken on both the maxillary (upper jaw) and mandibular (lower jaw) arches. A partial denture can then be used although patients may prefer fixed dental implants.
What this means is the insertion of the implants in the usual way followed by the placing of the restorations.
As mentioned before: the condylar mandibles are those parts of your jaw which act as a hinge, to enable your jaws to open and close. In effect, this is your ‘jaw joint’.
However, they can be damaged as a result of an accident or injury, for example a fracture and so will require treatment. If they are severely damaged then your ability to open and close your jaws will be affected. This can cause all sorts of problems, for example, chewing food.
This can show itself in a wide range of symptoms such as pain and discomfort, headaches and difficulty with biting and chewing.
Another reason for this surgery is that of ‘temporomandibular disorder’: this is a medical condition in which the patient experiences headaches, pain and jaw locking. This can be caused by a variety of factors, one of these being stress and nervous tension.
Treatments for this include tightening, or releasing the muscles around the jaw, a dental splint or surgery – condylar replacement.
Surgery is considered a last resort method.
Condylar replacement can involve the insertion of specially constructed components into the jaw, followed by implants and restorations.
As you can imagine this is a complex form of treatment and not one to be entered into lightly.
Crown and Bridge Reconstruction
This is another complex procedure in which treatment is required on the teeth in both the upper and lower jaw.
This can involve the dentist having to make a special wax model of your current teeth in order to decide where to insert the dental implants. He or she will also take an x-ray of your mouth which is used to help with the positioning of the implants.
It is vitally important that the implants are inserted correctly. One these have fused with the bone the dentist will then make a cast – from an ‘impression’ (wax or clay model) of your mouth which is used for the construction of your new false teeth.
The process involves a series of stages which start with the initial diagnosis through to the insertion of the implants, and the placing of the new restorations.
With the restorations; some patients prefer to have ‘fixed’ restorations whereas others prefer the ‘removable’ type.
What are these?
Fixed restorations are artificial teeth which are fixed in place by the dentist. They look and operate in exactly the same way as your normal teeth. A good way of thinking of these is as a permanent denture.
Note: these can only be removed by your dentist.
Removable restorations are teeth which you can take out. This means easy access to cleaning and caring for them in general.
However, some people don’t want the hassle of this and prefer the fixed sort.
Grafting for Implant Placement
There are patients who require a bone graft because their jawbone lacks sufficient depth to hold the implants in place. This means taking bone from one area of the body or a ‘donor site’ before grafting it into the jawbone. This is done to increase the width and depth of the bone.
This bone is taken from either the chin or the hip.
The dentist will build up the ridge of the jawbone before inserting the implant. There are 4 types of grafts available although the autogenous or allograft is the most popular choice of graft. The graft is held in place by tacks and a barrier membrane.
Once the graft has taken place the site is ready for the implants. These are inserted in the normal manner.
This sounds like a major form of treatment and in many cases it can be as it can involve dental implants in both the upper and lower jaw, a sinus lift and the restorations.
The dentist will use x-rays to help diagnose the problem as well as a template to aid with the placing of the implants. The implants will be inserted in the usual two stage process which can also include a sinus lift.
Once the implants have fused to the jawbone, in a process called ‘osseo-integration’, they are ready for the placing of the restorations (artificial teeth). The restorations look and behave in exactly the same way as natural teeth.
This complex procedure is carried out when there is problem with both sets of teeth, and the palate.
Note: the upper jawbone is referred to as the maxilla and the lower jawbone as the mandibular.
There are a few stages to this treatment.
This complex form of treatment starts with diagnostic x-rays in order to see the extent of the damage. You may then be asked to wear a temporary denture for a short period of time. This serves two purposes: the first is for aesthetic reasons in that you don’t want unsightly gaps in your mouth. The second is so you have time to get used to having artificial teeth.
After a period of time you will then undergo dental implants. The usual method of treatment is for them to be inserted in a ‘two stage’ process: the first stage is where the implant is inserted into the jawbone, and the second is where the artificial teeth or restorations are fastened to the implants via the abutment.
As several implants will be required the dentist will use a special type of device called a ‘Hader Bar System’. This is a thin metal bar which clips onto the implants to hold them in place. Three or four implants can be held by a single Hader bar.
A Lower Hader Bar is used in the lower jaw and an Upper Hader Bar in the upper jaw.
If the dentist feels that your jawbone is too thin to support implants then he or she will recommend that you have a bone graft. There are four types of these grafts and they all involve the grafting of new bone into the jaw to increase its depth. This procedure is carried out before the insertion of the implants.
Once the implants have been inserted and allowed time to fuse with the jawbone, the next stage is the placement of the new teeth. An overdenture is likely to be put in place. This is a type of denture, with artificial teeth, which fits over the implants.
Reconstruction with Sinus Lift
This treatment is carried out to resolve the problem of missing teeth. If you have missing teeth in your lower jaw then your dentist will advise you to have dental implants. He or she will also recommend a bone graft if your jawbone is too thin to hold the implants.
This procedure is easier to perform on the lower jaw than the upper jaw.
Why is this?
The main reason is that the upper jaw tends to be thinner than the lower jaw plus there is the problem of the sinuses. The sinuses are ‘air spaces’ in your head and in this case, are situated above your upper jaw. If your upper jawbone is too thin then an implant cannot be inserted as there is not enough bone to hold it. In fact, it will be inserted into thin air!
So, the dentist will have to build up the sinus area above your upper jaw. This means a procedure called a ‘sinus graft’.
Once this has been done the next step is the insertion of the implants. Your jawbone has extra depth and width as a result of the sinus lift which means that these implants will stay fixed in place.
Once this has taken place then the implants are given time to heal and fuse with the jawbone.
Then, your dentist will fix a small component or ‘abutment’ on the end of the implant which allows him/her to fix the restorations onto the implants.